Selling Dead Fish

If the NHS reforms continue and fail it won’t be a failure of communications, after all the coalition Government has repeated stated that it was listening. Listening does not equate to agreeing. Nor will be a failure of will or effort, for these changes come with ready built-in non returnable determination. No, if the NHS reforms continue and fail it will be a failure of intellect.

But how did we come this far to dismantling the NHS. How did we slide closer and closer to the precipice?

There is an idea that if you win the hearts and minds of a few leaders the rest will follow like so many sheep. Keep meeting the same, tame leaders, flatter them a bit, put them in charge of a think-tank, tell them what you want them to say and send them out to spread the word to the rank and file. Except that it doesn’t work. You don’t hand opinion farmers ready-rolled opinions and then expect them to go forth and influence. They have inconvenient minds of their own, so do their victims. They all need convincing, with something long forgotten and devalued in business culture – experience.

If you were selling cars, would you get ten of the country’s leading drivers in a room, suck up to them, hand them a 300 page document describing your new car then tell them to go away and tell their friends? And if you did, how many cars would you expect to sell? You would create an advertising campaign to sell the benefits. You would get Jeremy Clarkson and his motley crew of middle-aged male petrol-heads to drive it irresponsibly fast and then put it on TV so that people of a similar demographic can drool over it. You might even set up a Facebook page, get a few cheeky celebs to tweet their approval, buy some space on cool websites for teaser ads, put some never before released footage on Youtube, create a buzz and get people talking about it. Remember hype conceals as much as it reveals.

It was once said of Hewlett Packard’s marketing that if the company was selling sushi it would call it raw, dead fish. Reading through the papers that pour out of government (which are ignoring professional bodies and academic institutions, like the King’s Fund) one can only conclude they were all on the same training course. On the surface these “modernisations” are fine ambitions to which every right thinking person aspires, and it would be if it any of it were true.

Lets examine the premises of these reforms.

1. Involving doctors more closely in commissioning decisions.

Most doctors are extremely uncomfortable with having more accountable for buying in what they can afford and leaving what they cannot.

It doesn’t close the gap between health and social care. It opens it wider to a point where the needy and dispossessed are somehow meant to disappear without trace.

It doesn’t address inequalities of health nor does it make for better services.

2. It improves patients choice.

Patients are also told that they will be more involved in the design of local services. Why on earth would they want to do that? Feeling poorly? Take your mind off it by co-producing an integrated care pathway with your clinical commissioning group.

Now the doctors have taken industrial action, and not for nothing: what’s in it for them? How they can be asked to more accountable? How can have governance, performance management, peer review and added regulation increase the time needed to heal patients. It’s like they are being told they must have extra homework, Saturday detention, and cross-country runs with cold showers followed by the high jump for shirkers. There will be more prefects and more rules, fewer holidays and less play time. There will be a lot more talk of freedom but many more visits to the headmaster’s office to prevent anyone from abusing it.

Yet somehow this brilliant, handsome, vote-winning policy comes over like an awkward duffer. How did it happen? Patients have been told that doctors would be responsible for commissioning a completely alien concept that means nothing to them and leaves the door wide open to incentive driven cuts and closures.

Yo Sushi calls it tasty Japanese food in a fun environment. The same product from the NHS would be sold under the slogan get your dead fish here.